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My Experience of Endoscopies in Private Practice

MN Parkar
 
By now I have carried out hundreds of upper GI (Gastroscopy) and lower GI (Sigmoidoscopy and Colonoscopy) in private practice. Many of these are referral patients and few of them have a follow-up. I am writing this article for the benefit of general practitioners who may be enlightened as to the wrong concept of symptoms of gastrointestinal tract especially upper GI system.
The following observations of mine may be beneficial to the practitioners:-
  1. So often the patient is referred to me as ? Duodenal ulcer but Gastroscopy shows gastritis - specially Antral Gastritis due to H-Pyloridis infection.
  2. A real duodenal ulcer is so rare that I have seen only one patient for every hundred gastritis patients.
  3. Often the doctors have referred me as a case of ? Duodenal ulcer and I find gastroscopic appearance nearly normal. But if I take a biopsy of antral area - the report finally proves the diagnosis of antral gastritis due to H-pyloridis.
  4. Often the patient is referred to me as ? Peptic ulcer and gastroscopic examination shows reflux oesophagitis and the stomach including a biopsy of antral area is absolutely normal.
  5. Quite often the patient is referred to me as ? Reflux oesophagitis and the gastroscopy examination shows gastritis - often Antral Gastritis.
  6. Patients who are consuming heavy amount of tobacco, alcohol or cigarettes sometimes show generalised gastritis possibly due to the addiction with or without evidence of Antral Gastritis or Duodenal Ulcer.
  7. Very often the patient is referred as a case of Reflux Oesophagitis but the oesophagus looks absolutely normal but sometimes the hiatus appears lax.
  8. Patients referred for sigmoidoscopy - with a diagnosis of Irritable Bowel syndrome and who are constipated - Most of the times the sigmoidoscopy is normal. Sometimes I notice internal piles or a fissure. Rarely I find evidence of proctitis and on questioning the patient admits of having the habit of finger evacuation. Sometimes this area is so raw that I can see blood oozing which may be the cause of passing drops of blood in the stool.
  9. I have made it a principle - to do multiple colonic or Ileal biopsies in patients referred for chronic diarrhoea, because often the naked eye diagnosis of the lesions and the ulcers goes wrong. Again I often send 2 specimens to two different histo-pathologists and off and on we find difference in the interpretation and the diagnosis.
  10. Finally since fibro-optic colonoscope has come in addition to sigmoidoscopy, it is not too much effort to see the rest of the colon and depending on the preparation of the patient, even terminal Ileum can be seen and biopsied to exclude TBs and Crohn’s.

Consultant Surgeon - Therapeutic Endoscopy and Laparoscopy

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